唾液腺肌上皮癌的诊断误区:3例细胞学-组织学相关性和分子分析研究。

IF 3.2 Q2 PATHOLOGY Head & Neck Pathology Pub Date : 2024-10-15 DOI:10.1007/s12105-024-01698-3
Shweta Agarwal
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引用次数: 0

摘要

背景:肌上皮癌(MECA肌上皮癌(MECA)代表 设计:对MECA进行了为期10年的数据库搜索。3例病例符合细胞组织学相关性要求。所有病例在形态学上均为 MECA,其中一例被诊断为 MECA ex-PA。对这些病例进行了全面的免疫组化和分子评估(1号病例先前已有报道,并于2021年发表在《头颈病理学》上):这些病例的对比分析见表 1。三例病例最初均被细胞学诊断为 PA。审查细胞学切片时发现,变色基质碎片和平滑肌上皮细胞的存在是最常见的诊断误区。S100 在所有病例中均呈阳性,而肌球蛋白、p63 和 GFAP 则呈不同程度的阳性。分子分析表明,这三个病例存在以前未曾描述过的新型突变。此外,三个病例中有两个表达PD-L1,这表明免疫疗法在治疗中的作用:结论:MECA的细胞形态学在文献中描述较少,由于其特征与唾液腺良性肿瘤重叠,可能会给诊断带来挑战。通过细胞学检查往往无法确诊。不过,涂片和细胞块上的高细胞度、以肿瘤细胞/肌上皮细胞为主的细胞群,以及临床和放射学上对唾液腺恶性肿瘤的强烈怀疑,应引起细胞病理学家的警惕,并有助于避免细胞学上的错误良性诊断。
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Pitfalls in Diagnosis of Myoepithelial Carcinoma of Salivary Glands: A Study of 3 Cases with Cytologic-histologic Correlation and Molecular Analysis.

Context: Myoepithelial carcinoma (MECA) represents < 1% percent of salivary gland (SG) tumors with a mean age of 55 years. These tumors can arise de novo or in association with pre-existing pleomorphic Adenoma (PA). The cytologic features of MECA overlap with other SG neoplasms including the more common benign entities like PA and myoepithelioma and can pose a diagnostic challenge.

Design: A database search for MECA was performed spanning 10 years. 3 cases qualified with available cyto-histologic correlation. All were morphologically MECA with one case diagnosed as MECA ex-PA. The cases were subjected to a comprehensive immunohistochemical and molecular evaluation (Case#1 has been previously reported and published in head and neck pathology in 2021).

Results: A comparative analysis of these cases is presented in Table 1. All three cases were initially diagnosed as PA on cytology. On review of cytology slides, presence of metachromatic stromal fragments and bland myoepithelial cells was found to be the most common diagnostic pitfall. S100 was positive in all cases while myosin, p63, and GFAP were variably positive. Molecular analysis revealed novel, previously undescribed mutations in the three cases. Additionally, two of three cases expressed PD-L1, suggesting a role for immunotherapy in treatment.

Conclusions: Cytomorphology of MECA is poorly described in literature and can pose a diagnostic challenge due to overlapping features with salivary gland benign neoplasms. A conclusive diagnosis on cytology is often not possible. However, a high cellularity, predominant oncocytoid/ myoepithelial cell population on smears and cell block, along with a strong clinical and radiologic suspicion for malignant salivary gland tumor, should alert the cytopathologist and help avoid an erroneous benign diagnosis on cytology.

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来源期刊
CiteScore
5.70
自引率
9.50%
发文量
99
期刊介绍: Head & Neck Pathology presents scholarly papers, reviews and symposia that cover the spectrum of human surgical pathology within the anatomic zones of the oral cavity, sinonasal tract, larynx, hypopharynx, salivary gland, ear and temporal bone, and neck. The journal publishes rapid developments in new diagnostic criteria, intraoperative consultation, immunohistochemical studies, molecular techniques, genetic analyses, diagnostic aids, experimental pathology, cytology, radiographic imaging, and application of uniform terminology to allow practitioners to continue to maintain and expand their knowledge in the subspecialty of head and neck pathology. Coverage of practical application to daily clinical practice is supported with proceedings and symposia from international societies and academies devoted to this field. Single-blind peer review The journal follows a single-blind review procedure, where the reviewers are aware of the names and affiliations of the authors, but the reviewer reports provided to authors are anonymous. Single-blind peer review is the traditional model of peer review that many reviewers are comfortable with, and it facilitates a dispassionate critique of a manuscript.
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